Strength in weakness: a mystery of hope

An Inevitable Experience

A Christian understanding of medical vocation leads many people to serve in severely resource-limited settings, and it is impossible to serve for any substantial time in such a setting without being confronted with your own massive insufficiency. The sensation is somewhere between a blow to the gut and a blow to the head. Either way, it has often stopped me in my tracks. I cannot avoid the fact that I am just not enough.

This insufficiency can come in a few different flavors. Many times, I am insufficient because of factors beyond my control. The treatment is not available here. The patient can’t pay for the test. The electricity went out at a bad time. The medicine is out of stock. However, sometimes I wonder whether or not I’m using even the scant resources available to me in the right way. Should I give this treatment without a confirmed diagnosis? Can I justify letting her wait three months to follow-up given how hard it is for her to pay for transport? Guidelines that are well-adapted to our contexts are hard to come by, and so we are obliged to figure it out on our own, which feels roughly akin to pushing our patients ahead of us down a dark and dangerous path.

Most difficult of all are the times when I am quite sure that I missed something.¹ The insufficiency becomes failure and centers down onto me like a spotlight. I should have noticed that physical exam finding earlier. I should have asked if she had a history of DVT. And now something happened. My patient trusted me, and I don’t feel worthy of that trust.

My glaring insufficiencies haunt me. These experiences hurt, leaving me in a whirl of anger, guilt, disgust, and disorientation.² I have entered into the very difficult settings with a sense of responsibility to use my medical skills to serve well, and yet I find the world without and my capacity within far from enough to carry out this responsibility.³

The Weakness is Intentional

In 2 Corinthians 12, Paul gives us a very mystical story where a glorious spiritual vision is followed by him receiving a “thorn in the flesh.” He pleads three times for the thorn to be taken away, but instead he receives a sort of promise. God says “My grace is sufficient for you, for my power is made perfect in weakness.” (2 Cor 12:9)

For a long time, I mentally changed the preposition from “in” to “despite.” I assumed that the meaning of the words was effectively “Don’t worry. Despite your weakness, my strength will go forward.” It was when I started practicing medicine in rural Africa that I realized both that this is not what the text says, nor is it consistent with the rest of scripture.

The promise is rather that God’s strength is made perfect precisely in our weakness. The weakness is intentional. Paul was made weak (in this case) to keep him humble after his glorious vision. In chapter one, Paul “received the sentence of death” in order that he might know God’s resurrection power. (2 Cor 1:8-10) Elsewhere, Gideon’s army is winnowed down so that Israel would know that the victory belonged to God. (Judges 7:2) God is glorified by Goliath’s death precisely because David could not have been victorious on his own. (1 Sam 17:47) Jesus says we must become like little children to enter God’s kingdom (Matt 18:2), and that it is the hungry, the poor, and the meek that are blessed (Matt 5:3-6). These are images of God’s strength being made perfect in our insufficiency. The weakness is intentional.

“My power is made perfect in weakness.” Any Christian health care worker in resource-limited settings could find great comfort here. However, the thoughtful Christian might soon ask the question of “How?” How is God’s strength made perfect in the stark imbalance of care options made available to people based on the circumstances into which they were born, or in my uncertainty as to the right thing to do though it makes a huge difference for the lives of my patients, or in the death of the child before me?

I don’t know. I do not think that it will be helpful for any of us to pretend that we do know. That God’s power is made perfect in weakness is a promise and a mystery and should only be treated as such. But while a mystery is something that we can not totally understand, it is not something that we cannot understand at all.⁴ The comfort that I feel here is not unimaginable. As I have wrestled with this question for many years, I have seen the reality of the promise manifest in several different ways, three of which may be helpful to describe here.

Humility, Compassion, and Praise

Why is weakness so hard for me? As a physician, medical training and culture have given me a belief that when I am doing my role well I will be able to help the person in front of me in the way that they are requesting. Yet reality shows that this is often not true. I am a healer, yes. I am not God, but rather his creature, which implies limits.⁵ My heart’s rejection of weakness is often a mask of pride denying that God’s expectations of me are not limitless, just as his love for me has never been conditioned on a certain level of effectiveness.

As I have pondered the question of “how is God’s strength made perfect in my particular weakness?”, my first conclusion is that not knowing is part of the point. As a physician, I am used to knowing and deciding on that knowledge. But when I can’t know, I am forced to wait and trust. Sometimes, as I wait in my weakness, my pride dissolves. This is the same pride that is a poison in all my relationships, including my professional ones. My weakness can lead to humility. This is explicitly the effect of Paul’s thorn in 1 Corinthians 12 and in the command to become like little children in Matthew 18. God’s strength goes forward in our humility, which is most often grown out of weakness and failure. Doug McKelvey writes “Much better to have met defeat than to succeed at that which would blind me to my own poverty of soul.”⁶

In a similar way, weakness and failure can create compassion. We hear biblical echoes of this phenomenon in the book of Hebrews where the author describes Jesus’s sympathy for our weaknesses because of Jesus’s experience of his own incarnation. My favorite literary example of this comes from Thornton Wilder’s short play The Angel that Troubled the Waters. The scene is the pool of Bethesda from John 5, where the sick believed they could be healed on entering the pool. In Wilder’s scene, a physician comes to be healed of his melancholy but an angel bars his way. The physician tries to explain his desperation to the angel, who replies: “Without your wound where would your power be? It is your very remorse that makes your low voice tremble into the hearts of men. The very angels themselves cannot persuade the wretched and blundering children on earth as can one human being broken on the wheels of living. In Love’s service only the wounded soldiers can serve. Draw back.”⁷

From a more secular standpoint, medical educator Nicole Piemonte writes about how our vulnerability can lead to better medical education and practice. She says, “the humility that comes from recognizing that, as humans, we are all flawed and all suffer in our own ways can cultivate compassion and uncover the common bonds between us.”⁸ In my experience, one powerful opportunity for this is when a physician owns his or her insufficiency in front of those for whom they are caring. When patients see a compassionate response from their physician that recognizes his or her own limits, they are called to remember that there is a God over all of us that is our ultimate source of help and security. Thus, vulnerability shows us all a vital truth of God’s kingdom.

Lastly, weakness can lead us to praise and gratitude. Yesterday, in our morning hospital chapel, a Congolese nursing student was talking about trusting in the Lord on bus journeys because of the ever-present threat of bandits on the roads of nearby Eastern Congo. It was December 29, and the student then proclaimed that though there were a few days left in the year, he thought it was time to thank God who had protected us all to be able to see the next year. The room erupted in exclamations of praise and thanksgiving. Those who had been living in weakness and uncertainty had learned that their lives were in God’s hands and that God indeed was at work. Meanwhile, I, who have not lived in such uncertainty, sat there surprised at the praise all around me.

Weakness and failure can teach us that we are not in control, which is a worthy lesson precisely because it is true, and because when we see that, we understand better that God is at work. This leads to praise and gratitude.

Embracing the Mystery

Humility, Compassion, Praise. A very appropriate question at this point is to ask whether the cultivation of these virtues, valuable as they are, seems to be a sufficient redemption of the immense suffering which rides in the wake of our personal and collective failures. How can the suffering and death of our patients be justified by greater humility, for example?

This is an important question because Christianity proclaims that God is working to renew all things, not simply those that we call spiritual. When John the Baptist was in prison and doubting whether Jesus was really the Messiah, Jesus did not answer those doubts by saying that his kingdom was only a spiritual kingdom. He did not reply that his presence only transforms our hearts and our attitudes. Jesus’s response was rather mostly signs of physical healing to demonstrate the reality of God’s kingdom come.

Therefore, the first response to this important challenge is to return to mystery. God’s power made perfect in weakness is, by its very nature, something that will not be completely understood from the perspective of the weak. The above examples of how this can occur are not intended as a complete explanation, but rather as a way to spark our imaginations. Such imagination is needed in order to believe that this principle really does play out in the world, so that we can trust that it could be happening in other places and in other ways in the myriad other circumstances where we can’t currently imagine how.

Yet a word must be said in the defense of virtues. Many of us may tend to believe that sanctification is some kind of consolation prize compared to physical life and health. However, God renewing all things does certainly not exclude making us all people of humility, compassion, and praise. Many medical studies examining the connections between spirituality and physical health seek to show how spirituality improves physical outcomes, but certainly this is not a one-way street.⁹ Perhaps there are times when spending physical health in the interest of becoming like Jesus is a real good, and this may be true in countless lives all around us. As Scott Cairns wrote: “Paradise is filled with men and women whose cancer saved their lives.”¹⁰

Lastly, we must remember that these virtues which our failures and weakness may produce are in fact integral to the medical work of which we are a part. If we think that the gratitude, compassion, and humility of our own hearts are only minor actors determining the quality of care we provide, we likely do so at our peril and, perhaps more importantly, at the peril of those for whom we care.

Strength in Weakness

Christianity calls us all, including health care workers in resource-limited settings, to a hopeful promise that God’s strength is made perfect precisely in our weakness. Just as a certain power for healing is part of God’s vocation for our lives, weakness is also part of his plan. We need to speak these promises to one another and reflect on them deeply as we encounter great suffering.¹¹ The weakness is intentional, and it is a means of God bringing good to his creatures and glory to his name. This hope gives us a reason to be honest about such realities rather than hiding them. Our life experience suggests that we need to be serious about God’s strength being made perfect in weakness, because we know that such weakness is an inevitable part of what we will bring to the table.

Competing Interests

None declared.